National health priorities: resources for remote Australia Robert Williams 1 1 Royal Flying Doctor Service of Australia Introduction The Royal Flying Doctor Service of Australia (RFDS) provides a range of emergency, inter-hospital transfer and primary health care services through its four operating sections: Central Operations; Queensland Section; South Eastern Section and Western Operations. Primary health care services include general practice, Aboriginal and Torres Strait Islander health, women s health, mental health, health promotion and allied health provided to a range of remote locations including Aboriginal and Torres Strait Islander communities, rural support towns, stations/properties, mining sites and tourist resorts. A project, funded through RFDS, focuses on working with peak bodies addressing the seven national health priorities with the aim of assisting peak bodies in getting their message across to the remote context and ensuring that information and resources on key health issues are appropriate for the remote context. RFDS overview The RFDS is a national federated organisation composed of four operating sections providing direct service delivery and two support sections involved in public relations and fundraising. Across the four operating sections RFDS operates 21 bases which house aircraft and provide services and six health facilities which provide health services but do not have an aircraft. Each operating section is autonomous in its management however unity of the service nationally is achieved through shared service delivery funding from the Commonwealth, cooperative working relationships across the domains of health, aviation, finance, human resources and marketing and a coordinating National Office based in Sydney. RFDS Mission Statement To provide excellence in aero-medical and primary health care across Australia. The mission statement of the RFDS encapsulates the service s two primary functions: aero-medical work which includes emergency primary responses to severely unwell or injured remote patients and inter-hospital transfers taking people from hospitals which do not have the required services to larger hospitals; and primary health care which includes a range of regular clinic services provided to remote locations on a visiting basis. This paper focuses on RFDS primary health care services. RFDS Primary Health Care Services The RFDS adopts the principles of primary health care as outlined in a recent Commonwealth discussion paper on primary health care (Ref 1). These are summarised below: 10th NATIONAL RURAL HEALTH CONFERENCE 1
provide Services that are: accessible, clinically and culturally appropriate, timely and affordable patient-centred and supportive of health literacy, self-management and individual preference more focused on preventive care, including support of healthy lifestyles integrated, coordinated, and provide continuity of care, particularly for those with multiple, ongoing and complex conditions safe, and involve high quality care which is continually improving through relevant research and innovation implement better management of health information, underpinned by efficient and effective use of e-health adopt flexibility to best respond to local community needs and circumstances through sustainable and efficient operational models provide working environments and conditions which attract, support and retain a workforce provide high quality education and training arrangements for both new and existing workforce deliver services which are fiscally sustainable, efficient and cost-effective. The principles which this paper focuses on concern increasing health literacy and encouraging selfmanagement of health issues and a focus on the prevention/health promotion end of the treatment spectrum. RFDS health promotion programs The paper focuses on two national RFDS primary health care services, General Practice and the Rural Women s General Practice Service as well as three section specific health promotion programs: RFDS On the Road (Western Operations); RFDS Health promotion Field Day Program (Queensland Section), and RFDS Healthy Living Program (Central Operations). General Practice Program (National) The RFDS provides General Practice (GP) clinics across Australia with services which include assessment, treatment, referral and health promotion. Part of the GP role includes provision of information and access to resources related to health issues. The GP service is provided to Aboriginal and Torres Strait Islander Communities, rural support towns, stations/properties, mine sites and tourist facilities. Patient information and resources, and staff knowledge of these, need to be suitable for the remote contexts and currently access to such information is made by the RFDS medical practitioner on an individual basis. In a typical year approximately 4,000 GP clinics are run and 30,000 patients seen. The GP program is funded by the Commonwealth as part of its Traditional Services work. Rural WomenÊs General Practice Service (National) The RFDS manages the Rural Women s General Practice Service (RWGPS) which aims to improve access to primary health care services for women in rural and remote Australia who currently have little or no access to a female GP. While aimed at women, the RWGPS is open to all members of the 10th NATIONAL RURAL HEALTH CONFERENCE 2
community including men and children. Eligibility for an RWGPS clinic is achieved when a community is at least 50km from a practicing female GP and has a population greater than 1,000 (or a cluster or hub and spoke arrangement making up 1,000). Female GPs carry with them patient information and resources on specific health issues as well as relying on rural and remote area health staff for provision of locally available information. In a typical year over 1,000 clinics are held and 17,000 patients seen. The RWGPS program is funded by the Commonwealth government. RFDS On the Road (Western Operations) The RFDS On the Road program delivers primary health care services to people living, working and travelling in the Pilbara region (commenced July 2004) and Goldfields Esperance region (commenced May 2008). The Pilbara region program is sponsored by BHP Billiton Iron Ore and the Goldfields Esperance region program is sponsored by BHP Billiton Nickel West. A primary health care nurse and a project officer travel in 4WD vehicles to satellite mine and exploration sites, pastoral stations, Aboriginal communities, remote tourist facilities, roadhouses and isolated settlements running health promotion sessions on various health topics (see list below) and staff also run primary health care education and training activities at schools, hospitals, volunteer emergency service groups and at regional community events. To date the On the Road program has provided primary health care services at more than 240 isolated locations; and delivered health education and training services to more than 11,500 remote Western Australia residents. On the Road topics include: management of the RFDS medical chests remote area 1st aid training e.g. management of snake bite; giving injections; management of bleeding, fractures, dehydration etc. basic life support training (adult and child CPR and EAR) healthy lifestyle activities related to diet, exercise, drugs and alcohol, Injury prevention, mental health, prevention of chronic disease (Heart health, Cancer, Injury prevention, Men s health), etc one-on-one basic health consultations to assess an individual s health and discuss management strategies; screening for health risks assessments and management advice skin cancer, obesity, nutrition, blood pressure, cardiac, cholesterol St John Ambulance First Aid Courses 3 hour Basic and two day Senior First Aid emergency evacuation preparation procedures for paramedics, ESO s, health workers and volunteer emergency service personnel airstrip survey and information on RFDS standards for day and night landing 10th NATIONAL RURAL HEALTH CONFERENCE 3
Health Promotion Field Day Program (Queensland Section) Health Promotion Field Days are a cornerstone of RFDS primary health care practice with an emphasis on prevention, early intervention and health promotion activities. Health topics are determined in consultation with communities served. Field Days are held at station properties, roadhouses, national parks and islands and involve family groups, children, workers, tourists and visitors. An RFDS team flies to the remote location and the day s format involves practical activities, demonstrations and information sharing about issues relevant to people living in the bush. Some field days include a medical and child health clinic. Attendance at Field Days delivered by the Cairns RFDS base in 2008 show that a total of 319 people attended (86 men, 149 women and 86 children). Field Day topics in 2008 included: heart health: stroke awareness prevention, early detection of cancer heat stress/dehydration oral health/ sun smart for kids snake bite management suicide prevention managing depression/ anxiety stress management succession planning women s health men s health childhood illnesses childhood development communicating with RFDS emergency planning/scenarios medical chest review first aid. Healthy Living Program (RFDS Central Operations) The Healthy Living Program (HLP) operates from RFDS Port Augusta base and visits remote locations radiating up into South Australia. The HLP promotes and encourages healthy lifestyles and focuses on increased physical activity and improved diet. The HLP has been funded by the Li Ka Shing Foundation for 10 years from 2007. The vision and mission of the program is as follows: Vision: Generational improvement in the health outcomes of the people of Outback South Australia. Mission: Reduce the incidence of obesity related preventable chronic disease (e.g. cardiovascular, diabetes, musculoskeletal) by: increasing knowledge and awareness of the importance of healthy weight and obesity related health issues promoting the benefits of increased physical activity and improved diet 10th NATIONAL RURAL HEALTH CONFERENCE 4
building capacity and empowering people to make healthy lifestyle choices. In a 7 month period 45 Physical Activity, Weight Loss or Foodies sessions were held involving 363 attendances and as at March 2009 the program had 122 client files. The HLP team visits Coober Pedy, Marla/Mintablie, Oodnadatta, Marree, Copley, Nepabunna and Blinman on a monthly schedule and uses a virtual classroom (Centra) to provide an Internet delivery of the HLP s Secrets to Weight Loss program. The HLP program has also organised functions such as a Men s Health night held at Coober Pedy which had 55 attendees. Anthropometric data collected by the program to date shows some reduction in weight and waist measurement. RFDS Cancer Outback Project Over the last 12 months RFDS have received funding from Cancer Australia to conduct a small project to look at the information and support needs of patients, their families and carers who live in remote locations serviced by the RFDS. The project officer has interviewed a number of cancer patients and the following are a summary of the findings from these interviews: Some patients want information from all sources cancer organisations, health professionals, books, brochures and the internet. Others preferred not to have any information. The internet was reported to be an Information overload experience. Most remote patients stay in hostels in major centres and appreciated the information and individual and group support available in the hostels. Significant lack of culturally appropriate information and support for Aboriginal and Torres Strait Islanders. Remote hospitals are the main repository for cancer resources, information brochures and access to support groups if available. Health professionals reported to be reasonable at providing information (verbal or written) however did not recommend support groups very often. The best support was a partner/spouse. In a couple of cases in this study both partners had had cancer and were therefore of great support to each other. In one case animals and plants were a support. Isolation had been the strongest feature of the experience of cancer, particularly when at home in the remote community. Information and resources on cancer did not recognise the remote context and the challenges faced by remote residents. RFDS National Health Priorities Project Background People who live in remote and rural areas of Australia face particular problems both in terms of specific risk factors for the development of health problems and poor access to health services. Peak bodies addressing the seven national health priority (NHP) areas often face challenges in getting their 10th NATIONAL RURAL HEALTH CONFERENCE 5
message and resources out to these people and to health professionals who work in the remote and rural context. The Royal Flying Doctor Service (RFDS) delivers health services to the remotest parts of Australia and recognises the value of forming a strategic alliance with national peak bodies who wish to get their information and resources out to these locations. Funding has been provided through a RFDS Trust for the development of this project. Project aims This project seeks to form a strategic alliance between RFDS and the national peak bodies addressing NHP areas and to implement a preventative and early intervention program geared to the remote and rural context, with particular emphasis on the people who live in those remote settings served by the RFDS. The project also seeks to assist RFDS staff and other health professionals working in remote and rural practice. The national peak bodies include: Arthritis Australia National Asthma Council Australia Heart Foundation Diabetes Australia Australian Injury Prevention Network Beyondblue Cancer Council Project implementation It is envisaged that there will be several stages to the project, commencing with key stakeholder consultation and a needs analysis, the results of which will inform the strategy development and implementation stages of the project. The project in its initial phase will assess the current gaps and requirements of remote and rural consumers and health professionals in gaining access to information, support and resources across the NHP areas. Conclusion The paper provides an overview of RFDS services and describes in more detail primary health care services which include a health promotion component. The paper introduces a project which will work with peak bodies associated with the seven National Health Priorities to work towards ensuring that the messages from the peak bodies get across to people who live, work and travel to the remote context as well as guiding remote residents to information and resources on key health topics which are suitable for the remote context. Recommendations from the paper Ensure that health information and resources are suitable for the rural and remote context taking into account: recognition of features of the remote context, e.g. distance to services cultural fit 10th NATIONAL RURAL HEALTH CONFERENCE 6
appropriately contextualised. Ensure that rural and remote residents have good access to relevant information and resources on health issues. References 1. http://www.health.gov.au/internet/main/publishing.nsf/content/phs-discussionpaper 10th NATIONAL RURAL HEALTH CONFERENCE 7